Quality of Life in Patients with Rate Responsive Pacemakers: A Randomized, Cross-Over Study

Eleven patients with rate responsive pacemakers (7 men, 4 women, mean age 41 years with a range of 23-60) were randomly assigned to a cross-over study in order to assess their overall exercise capacity and quality-of-life (QOL) scores. All of the pacemakers were implanted for complete AV block or sick sinus syndrome. The pacemakers were randomly programmed into VVI or rate responsive (VVIR) pacing modes for 3-week study periods in each mode. At the end of each period, an exercise test was performed and the QOL was evaluated by the "Hacettepe Quality-of-Life Questionnaire". All patients exercised longer in the VVIR mode (mean 10.54 ± 0,73 min) than in the VVI mode (mean 7.81 ± 0.62 min) (P < 0.05). QOL scores were also found to be significantly higher in the VVIR mode (mean 173.81 ± 16.22 points) compared to the VVI mode (mean 156.27 ± 21.22 points) (P < 0.01). In conclusion, our results suggest that VVIR pacing offers a better QOL in addition to an improved exercise capacity, compared to the single chamber nonrate modulated pacing (VVI).     

Results of Short‐Term and Long‐Term Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation Using Duty‐Cycled Bipolar and Unipolar Radiofrequency Energy

PV Isolation Using Bipolar/Unipolar RF Energy . Background: Electrical disconnection of the pulmonary veins (PV) plays an important role in the ablation of paroxysmal atrial fibrillation (AF). Antral ablation using a conventional steerable ablation catheter often is technically challenging and time consuming. Methods: Eighty‐eight patients (mean age 58 ± 11 years) with symptomatic paroxysmal AF underwent ablation with a circular mapping/ablation decapolar catheter (PVAC). Ablation was performed in the antral region of the PVs with a power‐modulated bipolar/unipolar radiofrequency (RF) generator using 8–10 W delivered simultaneously through 2–10 electrodes, as selected by the operator. Seven‐day Holter monitor recordings were performed off antiarrhythmic drugs at 3‐, 6‐, and 12‐month follow‐up, and patients were requested to visit the hospital in the event of ongoing palpitations. All follow‐up patients were divided into 2 groups: Group 1 with a follow‐up of less than 1 year and group 2 patients completing a 1‐year follow‐up. Results: Overall, 338 of 339 targeted PVs (99%) were isolated with the PVAC with a mean of 24 ± 9 RF applications per patient, a mean total procedure time of 125 ± 28 minutes, and a mean fluoroscopy time of 21 ± 13 minutes. Freedom from AF off antiarrhythmic drugs was found in 82 and 79% of group 1 and group 2 patients, respectively. No procedure‐related complications were observed. Conclusion: PV isolation by duty‐cycled unipolar/bipolar RF ablation can be effectively and safely performed with a circular, decapolar catheter. Twelve‐month follow‐up data compare favorably with early postablation results, indicating stable effects over time. (J Cardiovasc Electrophysiol, Vol. 21, pp. 399–405, April 2010)     

Randomized Comparison of Multipolar,Duty‐Cycled,Bipolar‐Unipolar Radiofrequency Versus Conventional Catheter Ablation for Treatment of Common Atrial Flutter

Comparison of Radiofrequency Versus Conventional Catheter Ablation. Introduction: Radiofrequency (RF) catheter ablation has been established as an effective and curative treatment for atrial flutter (AFL). Approved methods include a drag‐and‐drop method, as well as a point‐by‐point ablation technique. The aim of this study was to compare the acute efficacy and procedural efficiency of a multipolar linear ablation catheter with simultaneous energy delivery to multiple catheter electrodes against conventional RF for treatment of AFL. Methods: Patients presenting to our department with symptomatic, typical AFL were enrolled consecutively and randomized to conventional RF ablation with an 8‐mm tip catheter (ConvRF) or a duty‐cycled, bipolar‐unipolar RF generator delivering power to a hexapolar tip‐versatile ablation catheter (T‐VAC) group. For both groups, the procedural endpoint was bidirectional cavotricuspid isthmus block. Results: Sixty patients were enrolled, 30 patients each assigned to ConvRF and T‐VAC groups. Total procedure time (40.2 ± 15.8 min vs 60.5 ± 12.7 min), energy delivery time (8.5 ± 3.7 min vs 14.7 ± 5.2 min), radiation dose (14.5 ± 3.5 cGy/cm² vs 31.7 ± 12.1 cGy/cm²), and the minimum number of RF applications needed to achieve block (4.2 ± 2.4 vs 8.9 ± 7.2) were significantly lower in the T‐VAC group. In 7 patients treated with the T‐VAC catheter, bidirectional block was achieved with less than 3 RF applications, versus no patients with conventional RF energy delivery. Conclusion: The treatment of typical AFL using a hexapolar catheter with a multipolar, duty‐cycled, bipolar‐unipolar RF generator offers comparable effectiveness relative to conventional RF while providing improved procedural efficiency. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1109‐1113)     

The Effect of Intracoronary β-Radiation on Neointimal Formation and Vascular Remodeling in Balloon-Injured Porcine Coronary Arteries: Effect of Dose Rate

Background: Neointimal formation and vascular remodeling are major mechanisms contributing to coronary restenosis after percutaneous transluminal coronary angioplasty. Intracoronary γ- and β-radiation have been shown to inhibit neointimal formation in balloon-injured porcine coronary arteries. However, the effects of Intracoronary radiation (ICR) dose and dose rate on vascular remodeling versus inhibition of neointimal formation have not been evaluated. Methods and Results: Forty-one Hanford Miniature swine were subjected to oversized balloon injury in the left anterior descending and right coronary artery. A spiral centering catheter with perfusion capabilities was placed in the injured segment for circumferentially uniform radiation dose delivery to the vessel wall. Each artery was randomly afterloaded with a dummy wire or an active wire with the ³²P source encapsulated in either a short (3 mm) or long (27 mm) segment at the distal end of the wire. The 3-mm source wire was used to deliver 650, 1,300, and 1,900 cGy while the 27-mm source wire was used to deliver 1,200 and 3,500 cGy of β-radiation to the adventitia (～ 0.5 mm into the vessel wall). The dose rate for ICR varied from 2.5 to 140 cGylsec, depending on the mCi strength of the ³²P source at the time of endovascular radiation. One month later, repeat coronary angiography and intravascular ultrasound (IVUS) to measure the external elastic lamina (EEL) area were done. The animals were sacrificed and the coronary vasculature was perfusion fixed. Morphometric, quantitative coronary angiographic, and IVUS analyses were carried out in a blinded fashion. A significant reduction in percent area stenosis (PAS) and neointimal area (NA) was observed on morphometry in coronary arteries treated with 3,500 cGy of β-radiation. The PAS and NA was 44%± 13% and 0.96 ± 0.25 mm² in the control groups versus 19%± 14% and 0.30 ± 0.23 mm² in the 3,500-cGy group (P < 0.02). There was no significant difference on morphometry between the control and the other four β-radiationtreated groups. There was no significant improvement in the change in minimum lumen diameter (ΔMLD) between the control and the five radiation-treated groups. Further analysis of angiographic data revealed that the apparent lack of beneficial effect on angiography was due to significant reductions in lumen diameter in the subgroups of arteries subjected to ICR at a dose rate > 50 cGylsec with the 3-mm source wire only. The ΔMLD was -1.39 ± 0.49, –1.79 ± 0.64, and -1.79 ± 0.39 mm in the 650-, 1,300-, and 1,900-cGy groups treated with a dose rate > 50 cGylsec versus -0.56 ± 0.95 in control (P < 0.05). This reduction in lumen diameter on angiography was associated with a significant reduction in vessel (EEL) area especially in the groups treated with the 3 mm source at a dose rate > 50 cGylsec. The EEL area was 8.8 ± 1.7, 9.9 ± 1.7, and 8.9 ± 0.6 mm² in the 650, 1,300, and 1,900 cGy groups treated at a dose rate > 50 cGylsec compared to 11.7 ± 1.6 mm² in control arteries (P < 0.001). Conclusions: Endovascular β-radiation at high doses (3,500 cGy to adventitia) and dose rate < 50 cGylsec inhibits restenosis after balloon injury in the porcine model of coronary restenosis. This dose and dose rate is associated with a neutral effect on vascular remodeling. While lower doses of ICR did not worsen the PAS, a reduction in MLD and EEL area were observed. However, this adverse effect on angiographic restenosis and vascular remodeling appears to be largely limited to the subgroups treated at dose rates > 50 cGylsec.     

Sucralfate for posttonsillectomy analgesia

Pain is one of the most troublesome complications of tonsillectomy. The pain appears as throat pain, otalgia, or both, and continues until mucosal recovery on the tonsillar fossae is complete. Some surgical and hemostasis techniques may increase pain. Analgesics, antibiotics, steroids, and local and topical anesthetics are used to relieve posttonsillectomy pain, but none has the desired effectiveness. The pain reliever must not increase bleeding and must have minimal side effects. Sucralfate, a basic amino salt of sucrose octasulfate, binds to the matrix protein of a peptic ulcer and produces a protective barrier. Tonsillectomy leaves two large ulcerous wounds, and sucralfate may bind those wounds as it does peptic ulcers. In this controlled study, the efficacy of sucralfate on posttonsillectomy throat pain, otalgia, analgesic requirement, degree of strength, bleeding, body temperature, and mucosal recovery is investigated in 80 patients. Sucralfate is found to significantly reduce throat pain and analgesic requirement after surgery. (Otolaryngol Head Neck Surg 1998;119:700-4.)     

Verbal autopsy in Karachi slums: comparing single and multiple cause of child deaths

Background: Children dying in developing countries often havemore than one serious disease process. Identifying the singlemost important is difficult and risks omitting valuable information.We report patterns of childhood death in Karachi slums comparingsingle and multiple cause analysis. Methods: The Aga Khan University has developed primary healthcare programmes in Karachi slums where community health workersmaintain monthly surveillance of families with children agedunder five years. We investigated all deaths among childrenunder five from 1990 to 1992 when the overall IMR was 78. Weused a structured verbal autopsy questionnaire comprised ofverbatim and symptom check-list sections. Reviewers assignedup to four diagnoses per death. We compared analysis by single(main) cause and multiple (consolidated) causes per case. Results: Overall, the 431 cases had 627 causes of death; 156cases (36%) had more than one cause of death. By consolidatedanalysis, diarrhoea, malnutrition, low birth weight (LBW), acuterespiratory infection (ARI), and vaccine preventable diseasesplayed roles in 41%, 24%, 22%, 13%, and 2% of deaths, respectively.Proportionate mortality ratios by main cause (1 diagnosis perchild) analysis for the same diagnoses were: 39%, 1%, 8%, 11%,and 1%, respectively. Half of all child death occurred by age3 months. Eighty-three per cent (146/176) of fatal diarrhoeasyndromes were due to acute watery diarrhoea, and 41% (72/176)were associated with severe malnutrition (vs 21% [12/56] offatal ARI cases). Each verbal autopsy cost an estimated US$4.00,an annual cost of US$0.08 per programme child. Implications: Compared to single main cause analysis, consolidatedanalysis more completely assesses reasons for child death toguide programme response. We propose that health planning forpopulations with low vaccine coverage or common co-morbid conditions,such as malaria and anaemia, would particularly benefit fromanalysis of death seeking multiple causes.     

Metastatic Carcinoma Simulating Linitis Plastica of the Colon

Reported herein is the case of a 70-year old woman with metastatic breast carcinoma presenting as linitis plastica of the ascending colon. The breast tumor was diagnosed nine years previously. The clinical, roentgenographic and pathologic features of colonic linitis plastica and the preoperative diagnostic difficulties are discussed. There is no difference in the morphologic features of primary and secondary linitis plastica. The latter may result from anaplastic carcinoma of the stomach, gallbladder or breast.     

以家犬驱虫为中心的棘球蚴病控制措施在新疆两县的应用

目的 通过新疆呼图壁县和温宿县区域试验,验证以家犬(包括牧犬）驱虫为中心的棘球蚴病控制措施的可行性和控制效果。 方法 1987-1990年在新疆呼图壁县和1990-1994年在新疆温宿县分别建立棘球蚴病控制试验区,采用消灭病原以阻断循环链的控制策略,即“犬犬驱虫、 月月投药”的措施,对试验区所有家犬用吡喹酮药饵剂型进行预防性驱虫。实施控制措施后,每年在试验区检测犬的细粒棘球绦虫和绵羊的棘球蚴感染率,以评价驱虫效果。 结果 经过连续3~4年实施“犬犬驱虫、月月投药”措施,呼图壁县和温宿县的家犬细粒棘球绦虫平均感染率分别从实施前的18.5%和14.7%降为0;两县新生绵羊的棘球蚴平均感染率比控制模式实施前降低了85%以上。 结论 以家犬驱虫为中心的策略,即“犬犬驱虫,月月投药”的措施对控制家犬的棘球绦虫病和绵羊的棘球蚴病是有效可行的。